Early Detection and Prognostic Assessment of Cutaneous Melanoma

Abstract

ImportanceTherapy for advanced melanoma has transformed during the past decade, but early detection and prognostic assessment of cutaneous melanoma (CM) remain paramount goals. Best practices for screening and use of pigmented lesion evaluation tools and gene expression profile (GEP) testing in CM remain to be defined.ObjectiveTo provide consensus recommendations on optimal screening practices and prebiopsy diagnostic, postbiopsy diagnostic, and prognostic assessment of CM.Evidence ReviewCase scenarios were interrogated using a modified Delphi consensus method. Melanoma panelists (n = 60) were invited to vote on hypothetical scenarios via an emailed survey (n = 42), which was followed by a consensus conference (n = 51) that reviewed the literature and the rationale for survey answers. Panelists participated in a follow-up survey for final recommendations on the scenarios (n = 45).FindingsThe panelists reached consensus (≥70% agreement) in supporting a risk-stratified approach to melanoma screening in clinical settings and public screening events, screening personnel recommendations (self/partner, primary care provider, general dermatologist, and pigmented lesion expert), screening intervals, and acceptable appointment wait times. Participants also reached consensus that visual and dermoscopic examination are sufficient for evaluation and follow-up of melanocytic skin lesions deemed innocuous. The panelists reached consensus on interpreting reflectance confocal microscopy and some but not all results from epidermal tape stripping, but they did not reach consensus on use of certain pigmented lesion evaluation tools, such as electrical impedance spectroscopy. Regarding GEP scores, the panelists reached consensus that a low-risk prognostic GEP score should not outweigh concerning histologic features when selecting patients to undergo sentinel lymph node biopsy but did not reach consensus on imaging recommendations in the setting of a high-risk prognostic GEP score and low-risk histology and/or negative nodal status.Conclusions and RelevanceFor this consensus statement, panelists reached consensus on aspects of a risk-stratified approach to melanoma screening and follow-up as well as use of visual examination and dermoscopy. These findings support a practical approach to diagnosing and evaluating CM. Panelists did not reach consensus on a clearly defined role for GEP testing in clinical decision-making, citing the need for additional studies to establish the clinical use of existing GEP assays.

Evaluating the support of pigmented lesion expert dermatologists for the use of skin self-examinations

“…The most important RFs identi ed were history of melanoma (100%), family history of melanoma (93%), and increased number of total body nevi (93%) (Table 1). These ndings align with RFs outlined in a consensus statement on optimal screening practices for melanoma which identi ed high-risk individuals as those with a personal and/or family history of melanoma [4].…”

Artificial intelligence and skin cancer

“…The climate, however, is evolving, with new reports incorporating additional clinicopathological data together with patient outcomes ( 70 ). Overall, there remains a lack of consensus on the use of the GEP biopsy and tape sampling tests ( 71 , 72 ). Further studies are needed, such as non-interventional retrospective studies, followed by prospective interventional trials, but there remains promise that they can become additional tools in providers’ arsenal of available tests.…”

Quantitative melanoma diagnosis using spectral phasor analysis of hyperspectral imaging from label-free slices

“…In recent decades, there has been a remarkable rise in the global incidence of melanoma skin cancer (1)(2)(3)(4)(5). This alarming trend has resulted in an elevated risk of one in 50 individuals in various Western societies.…”

“…This alarming trend has resulted in an elevated risk of one in 50 individuals in various Western societies. Melanoma, classified as a malignant melanocytic proliferation, can originate from melanocytes in the skin, mucosal tissues, or nervous system (3). Cutaneous melanoma is the most common form of melanoma and is characterized by aggressive behavior, propensity for metastasis, and significant impact on the patient's overall prognosis, particularly when early detection proves elusive (6)(7)(8)(9).…”